Jacqueline L Conner, MA, CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Columbus, MT

NPI 1447477997 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1447477997
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
781 (MT)
Practice address
525 N. Pratten
Columbus, MT 59019-7148
Phone
(406) 322-4789
Fax
(406) 322-4789
NPI assigned
Apr 19, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
781MTMDOptometrist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 781 MT Yes

Addresses

Primary practice location

525 N. Pratten
Columbus, MT 59019-7148

Mailing address

525 N. Pratten
Columbus, MT 59019-7148
Phone (406) 322-4789

Other identifiers

IdentifierTypeStateIssuer
660220OtherMTBCBS
0530725MedicaidMT

Other providers in Columbus, MT

All providers in Columbus, MT · Speech-Language Pathologist in Montana

Sources for this page

Verify at the official NPI Registry.